portal hypertension
Summary
Portal hypertension is elevated pressure in the portal venous system (> 12 mmHg) caused by increased intrahepatic resistance (cirrhosis), prehepatic obstruction (portal vein thrombosis), or posthepatic obstruction (Budd-Chiari). Causes esophageal varices, ascites, splenomegaly, and portal hypertensive gastropathy.
Detail
Portal hypertension results from obstruction to blood flow at any level: prehepatic (portal vein thrombosis, splenic vein thrombosis), intrahepatic (cirrhosis from alcohol, viral hepatitis, NASH, primary biliary cirrhosis), or posthepatic (Budd-Chiari syndrome, constrictive pericarditis, right heart failure). The most common cause is cirrhosis. Complications include esophageal and gastric varices (which can rupture and cause life-threatening hemorrhage), portal hypertensive gastropathy, ascites, hepatic encephalopathy, and spontaneous bacterial peritonitis. Splenomegaly and thrombocytopenia develop due to splenic sequestration. The Child-Pugh score assesses severity. Management includes beta-blockers (propranolol, nadolol, carvedilol) for variceal prevention, endoscopic variceal ligation for acute bleeding, and treating the underlying cause. Portal pressure gradient > 12 mmHg is the hemodynamic criterion for portal hypertension.
Sources
- First Aid for USMLE Step 1
- Harrison's Principles of Internal Medicine
- Robbins Pathology
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